Yesterday, the U.S. Department of Health and Human Services announced that Louisiana has received final federal approval to enroll residents in Medicaid using data from the Supplemental Nutrition Assistance Program (SNAP), more commonly known as food stamps. With this approval, Louisiana has become the first state in the country to receive approval to both determine Medicaid income eligibility and enroll people receiving SNAP benefits using this special "fast-track enrollment process."

The authority granted by the Centers for Medicare and Medicaid Services (CMS) allows the state to enroll individuals who are certain to be eligible for Medicaid without the need for a full Medicaid application because the financial eligibility requirements for Medicaid and SNAP are nearly identical and non-financial eligibility requirements are also already met.

Governor John Bel Edwards thanked CMS for expediting the approval of the state plan amendment, the formal request to make a change to the Medicaid program, to allow for the automatic enrollment of SNAP enrollees, as it will allow more people to get health care coverage as soon as July 1.

"Under Secretary Rebekah Gee's leadership, the Department of Health identified this approach as an innovative way to efficiently enroll people in Medicaid who already meet the financial requirements for food stamps. Because of this opportunity they will not have to go through a second application process in addition to the one for SNAP to receive Medicaid coverage. By coordinating efforts with the Department of Children and Family Services (DCFS), vulnerable Louisianans who could otherwise fall through the cracks and remain uninsured will get health care coverage beginning on July 1," said Edwards.

Dr. Gee added that other states have used a similar enrollment strategy through a Medicaid waiver. However, unlike the strategy CMS approved for other states, the plan approved for Louisiana will allow the strategy to be used at annual renewal as well as for the initial enrollment, and its use does not require the state to experience system constraints.

"Our Medicaid expansion team has identified more than 105,000 SNAP recipients that can be enrolled through this innovative strategy. We are mailing them letters in yellow envelopes, and people can expect to receive those between June 1 and June 10," said Gee. "Partnering with both CMS and DCFS means that people can apply for two of life's most basic needs, food and access to medical care, at one time and with only one application."

In addition to making it easier and more convenient for those who are eligible for Medicaid and SNAP, there is also a significant cost savings to the State. This innovation will save more than 52,000 man hours that would otherwise be spent by eligibility workers when enrolling this population, saving the State over $1.5M in estimated pay and benefits costs in addition to any associated administrative costs.

Questions and Answers

Question: How is Louisiana's strategy for SNAP-assisted enrollment different from the strategy already used by at least six other states to enroll people quickly into Medicaid through Medicaid waiver authority?

Waiver authority allows the state to enroll individuals who are "highly likely" to be eligible for Medicaid, but the actual income eligibility determination is deferred until later and must still be made. State plan amendment (SPA) authority authorizes the state to use SNAP household gross income to determine that an individual is "certain" to be income eligible for Medicaid.

Waiver strategy approval is dependent on eligibility systems constraints. SPA strategy does not require eligibility systems limitation and is sustainable.

Waiver authority is intended for initial enrollment only (CMS has approved continuations for one year for some states). SPA authority is not time limited and allows the state to use the strategy at regular annual renewals, including ex parte and administrative renewals. This will help ensure the future retention of individuals enrolled into Medicaid through this low-touch strategy and the sustainability of the associated administrative savings.

Question: Louisiana's current SNAP enrollment as of February 2016 was 872,223, so targeting ~105,000 individuals for SNAP-assisted enrollment seems low. Why not enroll more SNAP recipients using this new method?

It is important to note that more than 185,000 newly eligible adults who have been receiving limited Medicaid benefits through Take Charge Plus and Greater New Orleans Community Health Connections (GHOCHC), many of whom get SNAP, have already been automatically enrolled in Healthy Louisiana for coverage beginning July 1. Additional factors were applied to target only those adults certain to be eligible in the New Adult group. Children and adults who were already eligible under pre-Medicaid expansion rules are not included in the 105,000.

Question: What is a SNAP Medicaid offer letter and how must an individual respond?

The offer letter informs the person getting SNAP benefits that they can enroll in Medicaid. The letter is pre-populated with the names of the SNAP household members and asks the individual to answer four yes/no questions to gather information not included in SNAP data and provide a signature. This can be done by phone, fax, email or regular mail. A copy of the offer letter can be found by clicking here.

Question: What does Louisiana expect the rate of response will be to the SNAP offer letters?

The state believes we can achieve 50 percent enrollment or higher based on the response rate in other states and the actions we are taking to raise awareness of the option. Take up in Arkansas and West Virginia were initially 46 percent and 41 percent, respectively.

Question: What is LDH doing to increase the response rate to the SNAP offer letters?

LDH consulted with national and state experts in literacy and readability of written materials for creating the offer letter.

Offer letters will be mailed in distinct, canary-yellow envelopes rather than the standard white envelopes.

Using multiple outreach efforts to encourage recipients of yellow offer letters to respond. These efforts have included announcements through the news media, DCFS (which administers SNAP in Louisiana), community partners, health care providers and the five Healthy Louisiana managed care plans.

Question: What is LDH's estimate for administrative savings for each person enrolled through the SNAP enrollment strategy?

The strategy is expected to reduce the eligibility processing time for the Medicaid agency after they receive the request to enroll by an average of 25 minutes. SNAP enrollees who receive an offer letter will already have a pending case in the Medicaid eligibility system that is ready to approve. There will be no system checks to verify income and citizenship as they have already been established for SNAP, no data entry to set up either the household or case in the eligibility system, no paper or telephone application questions or input to process, no follow up phone calls and no additional documentation for the Medicaid eligibility worker to complete.

If Medicaid can enroll 50 percent of targeted SNAP individuals who would otherwise complete a full application for Medicaid expansion, the reduction in eligibility man hours to enroll 52,500 individuals would be about 52,626 hours, saving the State over $1.5M in estimated pay and benefits costs in addition to any associated administrative costs.

The Louisiana Department of Health strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state residents. To learn more about LDH, visit www.dhh.la.gov. For up-to-date health information, news and emergency updates, follow DHH's Twitter account and Facebook.